Lona DeNisco has lost track of the violent incidents that have taken place in the 20-odd years she’s worked as an emergency room nurse in Buffalo, New York. “There’s not one shift that goes by that a nurse doesn’t get punched, kicked, slapped, hair pulled. That happens every day,” she says. “I’ve been punched, taken to the ground.” She is also certain that the growing violence in the Buffalo community is spilling into her hospital, Erie County Medical Center. Recent shootings—most recently the mass shootings in which 10 people were killed at a local Buffalo supermarket on May 14, and at a Tulsa, Okla., medical facility on June 1, in which four people were shot to death including two doctors and a receptionist—are painful reminders that at any moment, violence could threaten her life, or the life of her patients, and that it seems to be up to her to keep things safe.
“We do train for mass casualties, we train for active shooters, but none of that really prepares you,” says DeNisco. “We could do drills all day long, right? That doesn’t mean [much] when I have a gun in my face.”
The shooting in Tulsa is an extreme example of a growing trend: violence against doctors, nurses, and other health care workers. According to Bureau of Labor Statistics data, health care and social service workers are five times as likely to be injured from violence in their workplace than other workers, and the number of such injuries has risen dramatically over the last decade—from 6.4 incidents per 10,000 workers annually in 2011, to 10.3 per 10,000 in 2020. Healthcare workers say the situation has become even worse during the COVID-19 pandemic; in September, nearly a third of respondents to a National Nurses United survey said they’d experienced an increase in workplace violence.
In part, this is likely because the pandemic has worn people so thin, and left them with less energy to interact politely. Regardless of their political party, tensions are high because many people are tired of the endless partisan back and forth on COVID-19, says Gordon Gillespie, a registered nurse who researches violence against health care workers as a professor at the University of Cincinnati. Many health care workers are exhausted by endless worrying—about personal protective equipment, the risk of getting sick, or having to pick up the slack for ill coworkers. “Everyone is just tired, and their resilience is down. And so when you have things happen, you’re more likely to escalate even faster,” says Gillespie.
The pandemic has exacerbated many of the underlying problems that lead to violence, revealing deep gaps in the American social safety net and health care system. And even more so than before the pandemic, doctors and nurses—and emergency room workers, in particular—must deal with the consequences. For instance, mental health issues, inadequately treated before the crisis, worsened for many people during the pandemic, which in many cases cut people off from support systems and added to daily stress. The change is visible to Murnita Bennett, a psychiatric nurse and DeNisco’s colleague, who says that some of the increase in violence she’s witnessed has been the result of patients not getting the care that they need.
“These patients who are violent, are put back right in the community. We’re keeping violent offenders in the hospital longer, instead of sending them to the state hospital where they could get more help. It’s appalling,” says Bennett. “I’m talking to the patients constantly, and their families, but I’m always [thinking], where’s my escape route? What’s my body language—[making sure] that I’m not showing any aggressiveness…. When you see what’s happened in Tulsa, it’s a reality for us to know that at any moment, someone could come in to harm us.”
The racism in the community that found its most horrifically visible form in the supermarket massacre, in which a gunman targeting Black people killed 10, has also contributed to an increasingly tense atmosphere at the hospital, says Bennett. In the decades she’s worked as a nurse, she says, there have been many times she was the “only Black face in the room” partly due to discriminatory hospital hiring practices. “I don’t think I would have been around this long if I didn’t fight,” says Bennett. “I fought many battles in this hospital.” Bennett says that the supermarket shooting was particularly frightening for her, because her mother lives in the same neighborhood, and in the last few years, she’s felt more nervous out in the community. “I’m always looking at white people, I’m thinking, Who is this guy? Whose truck is this? I’m looking at people differently,” she says.
Even while health care workers face greater challenges during the pandemic, they have less support. Understaffing is rife in U.S. health care, in part because patients have been sicker during the COVID-19 crisis and require more attentive care. As a result, patients don’t always get the care they want as quickly as they expect it, which can result in conflict. Meg Dionne, an emergency room nurse at Maine Medical Center in Portland, says that after a patient punched her this January, while she was 26 weeks pregnant, she looked hard at her own behavior. If she hadn’t been so busy, could she have kept him calm? “If you’re being pulled in 40 different directions, you can’t meet the needs of these people who are scared, and hurt, and more prone to escalate towards violence if they’re not properly cared for in a timely manner,” says Dionne.
Living with such a high risk of violence is clearly untenable, in the long term. Gordon argues that it’s key to train health care workers for violence, and to make it more difficult for people with violent intent to get into hospitals—which, he admits, is a challenge, because hospitals are designed to welcome people, not to lock down. Dionne, Bennett, and DeNisco all say they are tired of hospitals reacting to violence, instead of heading off problems. In Dionne’s opinion, the key is new legislation—such as the federal Workplace Violence Prevention for Health Care and Social Service Workers Act, which, among other things, would require facilities to develop violence prevention plans—which she feels would make hospitals more responsive to the safety concerns of nurses. However, Bennett and DeNisco argue that the violence won’t stop spilling into hospitals until it’s limited in their community—which, in part, they say, must include curbing gun violence and promoting gun safety. “Until people start to understand how fragile life is, we’re not going to change this,” says DeNisco.
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